Background:
The chronic care model provides a framework for improving the management of chronic diseases. Participatory research could be useful in developing a chronic care model–based program of ...interventions, but no one has as yet offered a description of precisely how to apply the approach.
Objectives:
An innovative, structured, multi-step participatory process was applied to select and develop (1) chronic care model–based interventions program to improve cardiovascular disease prevention that can be adapted to a particular regional context and (2) a set of indicators to monitor its implementation.
Methods:
Primary care clinicians (n = 16), administrative staff (n = 2), patients and family members (n = 4), decision makers (n = 5), researchers, and a research coordinator (n = 7) took part in the process. Additional primary care actors (n = 26) validated the program.
Results:
The program targets multimorbid patients at high or moderate risk of cardiovascular disease with uncontrolled hypertension, dyslipidemia or diabetes. It comprises interprofessional follow-up coordinated by case-management nurses, in which motivated patients are referred in a timely fashion to appropriate clinical and community resources. The program is supported by clinical tools and includes training in motivational interviewing. A set of 89 process and clinical indicators were defined.
Conclusion:
Through a participatory process, a contextualized interventions program to optimize cardiovascular disease prevention and a set of quality indicators to monitor its implementation were developed. Similar approach might be used to develop other health programs in primary care if program developers are open to building on community strengths and priorities.
Microparticles, also called microvesicles, are submicron extracellular vesicles produced by plasma membrane budding and shedding recognized as key actors in numerous physio(patho)logical processes. ...Since they can be released by virtually any cell lineages and are retrieved in biological fluids, microparticles appear as potent biomarkers. However, the small dimensions of microparticles and soluble factors present in body fluids can considerably impede their quantification. Here, flow cytometry with improved methodology for microparticle resolution was used to detect microparticles of human and mouse species generated from platelets, red blood cells, endothelial cells, apoptotic thymocytes and cells from the male reproductive tract. A family of soluble proteins, the secreted phospholipases A.sub.2 (sPLA.sub.2 ), comprises enzymes concomitantly expressed with microparticles in biological fluids and that catalyze the hydrolysis of membrane phospholipids. As sPLA.sub.2 can hydrolyze phosphatidylserine, a phospholipid frequently used to assess microparticles, and might even clear microparticles, we further considered the impact of relevant sPLA2 enzymes, sPLA2 group IIA, V and X, on microparticle quantification. We observed that if enriched in fluids, certain sPLA.sub.2 enzymes impair the quantification of microparticles depending on the species studied, the source of microparticles and the means of detection employed (surface phosphatidylserine or protein antigen detection). This study provides analytical considerations for appropriate interpretation of microparticle cytofluorometric measurements in biological samples containing sPLA2 enzymes.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The orphan nuclear estrogen-related receptor alpha (ERRalpha) and transcriptional cofactor peroxisome proliferator-activated receptor gamma coactivator-1alpha (PGC-1alpha) are involved in the ...regulation of energy metabolism. Recently, extensive cross-talk between PGC-1alpha and ERRalpha has been demonstrated. The presence of PGC-1alpha is associated with an elevated expression of ERRalpha, and the two proteins can influence the transcriptional activities of one another. Using a candidate gene approach to detect regulatory variants within genes encoding nuclear receptors, we have identified a 23-bp sequence (ESRRA23) containing two nuclear receptor recognition half-site motifs that is present in 1-4 copies within the promoter of the human ESRRA gene encoding ERRalpha. The ESRRA23 sequence contains a functional ERR response element that is specifically bound by ERRalpha, and chromatin immunoprecipitation shows that endogenous ERRalpha occupies its own promoter in vivo. Strikingly, introduction of PGC-1alpha in HeLa cells by transient transfection induces the activity of the ESRRA promoter in a manner that is dependent on the presence of the ESRRA23 element and on its dosage. Coexpression of ERRalpha and PGC-1alpha results in a synergistic activation of the ESRRA promoter. In experiments using ERRalpha null fibroblasts, the ability of PGC-1alpha to stimulate the ESRRA promoter is considerably reduced but can be restored by addition of ERRalpha. Taken together, these results demonstrate that an interdependent ERRalpha/PGC-1alpha-based transcriptional pathway targets the ESRRA23 element to dictate the level of ERRalpha expression. This study further suggests that this regulatory polymorphism may provide differential responses to ERRalpha/PGC-1alpha-mediated metabolic cues in the human population.
Many young Somali refugees experience long premigration waits and a poorly delimited transition period in a succession of countries before reaching their final destination. During this difficult ...passage, a myth dealing with departure and exodus is collectively constructed, and it serves as a dynamic, mobilizing dream that orients individual strategies. This substitution of "dream travel" for real travel during the transition period, especially if it is prolonged, may cause Somali youths to lose contact with reality and eventually to slide into madness. The authors' approach is based on three assumptions: (a) that pastoralism predisposes the Somali to value travel as a way of maturing, (b) that age-based peer groups create special migratory dynamics, and (c) that an ethic of solidarity involves many people in the adventure of a migrant youth. When trapped in an indefinite transition period, young men share khat-chewing sessions during which they relate success stories and dreams of leaving. Many grow frustrated with the delay, and if their departure plans fall through, the "dream trip" often becomes "dream madness." Actual cases illustrate how some young Somali get lost in their dreams. A young Somali's vulnerability is heightened when he extricates himself from the system of reciprocal obligations or when the liminal stage ends with the mourning of the impossible dream. In the universe of madness visited by some young Somali migrants, the boundaries between the real and the imaginary are poorly marked. The paper is based on fieldwork carried out in the Horn of Africa and in Canada, interviews with Somali immigrants and members of the community, and clinical psychiatric data collected in Montreal.
Urbanization is known to have a negative impact on biodiversity. However, it is possible to increase bird species richness in cities through local actions such as increasing vegetation density and ...diversity. My first objective was to compare bird density and diversity on the island of Montreal among four urban habitat types: low-density and medium-density residential sectors, and residential and natural parks. A second objective was to determine the presence of bird species assemblages within these four urban habitats and a third was to explore associative relationships among six mainly shrub-nesting bird species and the vegetation they use. Point counts were conducted in each of 103 locations. Environmental variables measured consisted of the type (coniferous versus deciduous), density and height of vegetation within each 1 ha sector. Results revealed a decrease in bird abundance from medium-density residential habitats, residential park, low density residential habitats to natural parks and an increase in diversity from medium density residential habitats, low density residential habitats, residential parks to natural parks. Bird assemblages were determined through correspondence analysis. Most bird species were associated with at least one type of urban habitat. Associations between bird species and vegetation were measured through canonical correspondence analysis. The six focal species associated with shrubs demonstrated different levels of association with different habitat variables.
The Humboldt Area Foundation proved to be an excellent venue for people to chat, eat, and drink. Event planning was performed by Josée Rousseau, Sue Leskiw, Jim Clark, and Adam Brown, with set-up ...help from Sue Calla and Gary Bloomfield. Josée put together a PowerPoint presentation showing volunteers in action and giving hour totals for certain types of tasks.
Stenotrophomonas maltophilia (Sm) pneumonia in immunocompromized hosts is an increasingly common nosocomial infection. Even though resistant to multiple antimicrobials, this gram-negative bacteria ...usually does not present with a fulminant course leading to a fatal hemorrhagic respiratory infection in neutropenic patients. We report here the case of a 63-year-old woman treated by intensive chemotherapy for acute myeloid leukemia (AML) who presented while severely neutropenic and thrombocytopenic a Sm pulmonary infection with hemoptysis leading to death in 48 h. The bronchoalveolar lavage (BAL) performed shortly before death was highly hemorrhagic and contained a striking amount of extra- and intra-cellular pathogens. Blood and BAL cultures grew S. maltophilia. Post-mortem examination revealed bilateral extensive intra-alveolar hemorrhage (IAH) associated with a great amount of microorganisms and severe bone marrow aplasia was observed without evidence of leukemia residual disease. Sm pneumonia usually does not evolve into such a devastating clinical picture although infections due to the bacteria are known to be associated with high morbidity and mortality. So far, the present observation is the fourth similar case reported in the literature. Even though an early diagnosis and an adequate antibiotic prescription may improve Sm infection prognosis, S. maltophilia proves difficult to eradicate due to a high resistance rate in part intrinsic but also in part acquired.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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